https://mcdn.podbean.com/mf/web/mzin94/kuhlefinal_-_1_30_23_305_PM8xr0p.mp3

EPISODE SUMMARY:

Dr. Carol Kuhle is the Director of Menopause and Women’s Health at the Mayo Clinic in Rochester, MN. With specialties in complicated menopausal, hormonal, and sexual health issues for adult women, Dr. Kuhle is giving midlife women the tools and treatments to feel their best. In today’s episode, we sat down with Dr. Kuhle to discuss how menopausal women should prepare for a doctor’s appointment, HRT risks, sexual issues correlated with breast cancer, and the future of menopause treatment.

First, we asked Dr. Kuhle how menopausal women should properly prepare for a doctor’s appointment to address their symptoms. She explained that if possible, midlife women should try and find a physician that specializes in menopause. Through the North American Menopause Society’s website, resources are available that help find menopausal physicians near you. However, no matter the doctor, you should ensure you have a clear list of symptoms and a family history to give to your physician at the appointment. By knowing your family history with breast cancer, cardiovascular health, and other issues, your physician can determine whether or not hormone replacement therapy is a viable option to treat your symptoms. When discussing HRT, we spoke to Dr. Kuhle about the risk factors of taking hormones. She told us that risk factors depend on age and circumstance. For women over sixty, they may experience changes in their coronary arteries, which puts them at higher risk for a stroke. Because of this, doctors are careful when putting them on HRTs. Doctors also look at the root of the issue to see if the symptoms are hormonal, neurological, sleep-related, trauma-related, or linked to alcohol use or romantic relationships. For testosterone, treatment can come in a cream and other forms. However, Dr. Kuhle warned against using the pellet form for hormone replacement therapy. HRT pellets are not FDA approved and cannot be removed once put in your body.

A lack of knowledge on menopause affects every aspect of society, including the medical field. Despite spending years in schools, many doctors, especially male doctors, are not given proper information on menopause or how to treat menopausal symptoms. Dr. Kuhle said that she believes men would benefit greatly from being educated on menopause, especially when it comes to their romantic relationships. For men with female partners, understanding sexual health issues correlated with menopause can help improve intimacy. For many women, their sexual health is affected by menopausal symptoms and can cause dryness, irritation, and low libido. Estrogen treatments not only improve sexual health and sex drive but also help treat vaginal health. Women who are in active treatment for breast cancer should not be on estrogen treatments, but there are moisturizer alternatives that can be used.

When asked what important questions midlife women should be asking their OBGYN, Dr. Kuhle recommended asking a doctor whether or not they’re comfortable prescribing HRTs. Not all OBGYNs are fully educated on or willing to give hormone replacement therapy, so it’s important to understand where your doctor stands before moving forward with treatment options. For those who do prescribe HRTs, many physicians find that the best time to give women hormones is during perimenopause. At that time, symptoms are their strongest and issues such as bone loss begin occurring, which HRTs can help with. We also spoke to Dr. Kuhle about sexual health issues correlated with breast cancer. She told us how as a result of breast cancer, women will often experience a lowered sex drive. Recently, a 24-week trial was conducted on breast cancer patients using the medication Flibanserin, a FDA approved medicine used to treat low libido. The study showed no adverse risks after 24 weeks on the patients. Along with medication, there are other treatments for improving sex drive in women with breast cancer, including a shot administered shortly before sexual activity that increases libido. Finally, we asked Dr. Kuhle what she believes the future of menopausal medicine will look like. She spoke about the continued advancements doctors will make in understanding not only menopausal symptoms but the science behind them. The medical field is already beginning to figure out the mechanisms behind hot flashes and why treatments such as estrogen and other non-hormonal medications can help alleviate them. The North American Menopause Society will also continue to be a resource for menopause, both through their website and at annual conferences that providers can attend to educate themselves on menopause.

Dr. Carol Kuhle

Carol L. Kuhle, DO, MPH, is a Consultant and Assistant Professor of Medicine in the Division of General Internal Medicine with a second appointment in the Division of Preventive, Occupational and Aerospace Medicine at Mayo Clinic, Rochester.   After completing a family medicine residency at Broadlawns Medical Center, where she was elected Chief Resident and later served as Chief of Staff, she completed a Geriatric Fellow at Mayo Clinic, Rochester and then was the founding Director of a Mayo Clinic Affiliated Geriatric Fellowship. She then completed a fellowship in Preventive, Occupation and Aerospace Medicine at Mayo Clinic, Rochester and a Master of Public Health Degree at the University of Minnesota in 2011. She was awarded teacher of the year on 5 occasions as faculty for the Geriatric Fellowship and Mayo affiliated Family Medicine Residency. In addition, she was appointed Senior Medical Advisor to the Public Health Department of Iowa by Governor Tom Vilsack and was the Founding President of the Board of Directors for a Not-for-profit company that brought discounted prescription medication to seniors in Iowa prior to the creation of Medicare Part D.

She is presently the Director of the Menopause and Women’s Health Clinic at Mayo Clinic, Rochester, MN which specializes in complicated menopausal hormonal and sexual health issues for adult women with a special focus on cancer survivorship. She is a Certified Menopause Practitioner with over 20 peer-reviewed publications, and a member of the Board of Directors for the Scientific Network on Female Sexual Health and Cancer.

In this episode, we discuss…

• [0:01] ThePerfect3
• [0:55] Guest Introduction
• [4:37] Start of Interview
• [5:51] Preparing for a Menopause Doctor’s Appointment
• [11:15] Risks in HRTs
• [21:41] Lack of Menopause Education in Medical Fields
• [27:12] Questions Midlife Women Should Ask Their OBGYNs
• [30:36] Sexual Issues Correlated with Breast Cancer
• [33:36] The Future of Menopause Treatment
• [36:51] Closing Thoughts
• [38:06] Outro

Useful Resources:

Mayo Clinic I [https://www.mayoclinic.org/]

Dr. Kuhle’s LinkedIn I [https://www.linkedin.com/in/carol-kuhle-d-o-mph-2049a157/]

North American Menopause Society I [https://www.menopause.org/]

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